Mechanical Aspiration Thrombectomy in the Treatment of Acute Limb Ischemia – A Real World Single-Center Safety and Efficacy Analysis

Sunday, March 30, 2025

3:27 PM – 3:36 PM CT

Location: Music City Center, 205 BC

Presenting Author(s)

Carter Wegner

Medical Student
FIU HWCOM, United States

Author/Co-author(s)

Rafey Khan, BS (he/him/his)

Medical Student
FIU HWCOM, United States
Khloe Gu, BS

OMS-III
Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, United States
CT

Christina Taragjini, BA

Medical Student
FIU HWCOM, United States
DK

Daniel Koerfer, MD

Research Associate
Miami Cardiac & Vascular Institute, United States
RM

Ronald Mora, MD

Interventional Radiologist
Miami Cardiac and Vascular Institute, United States
CD

Cristobal Ducaud, MD

Fellow
Miami Cardiac & Vascular Institute, United States
Brian J. Schiro, MD

Vascular and Interventional Radiologist
Miami Cardiac & Vascular Institute / Radiology Associates of South Florida, United States
Ripal Gandhi, MD, FSIR

Interventional Radiologist
Miami Cardiac & Vascular Institute, Miami Cancer Institute, United States
Adam Geronemus, MD, FSIR

Vascular & Interventional Radiology
Miami Cardiac and Vascular Institute, United States
RH

Raul Herrera, MD

Director, Research and Outcomes
Miami Cardiac and Vascular Institute, United States
Constantino Pena, MD

Clinical Associate Professor Radiology
Florida International Universirty and University of South Florida , United States

Purpose: Acute limb ischemia (ALI) is characterized by sudden reduction in limb perfusion and is associated with high one-year mortality (15-20%) and limb amputation (10-15%) rates despite timely intervention. No evidence exists favoring initial thrombolysis or surgery as preferred options for treatment when comparing limb salvage, amputation, or death at 30-day, six-months, and one-year intervals. Advancements in endovascular techniques, particularly the use of mechanical aspiration thrombectomy, have shown promise in improving outcomes, including restoration of flow and limb salvage, for patients with ALI. This study evaluated the safety and efficacy of mechanical aspiration thrombectomy as a first-line treatment.

Materials and Methods: This single-center retrospective cohort study identified 230 patients presenting with ALI between 2014 and 2023. Patients treated with mechanical aspiration thrombectomy as the first-line therapy (N=55) were included, and those treated with first-line thrombolysis or surgery (N=100) or had missing data (N=75) were excluded. The primary endpoints included mechanical aspiration thrombectomy efficacy measured by technical success and safety evaluated through in-hospital major amputation and mortality rates. Results reported as mean ± standard deviation or number (percentage).

Results: The study included 55 patients, 49.1% of whom were male and had a mean age of 70.5 ± 15.1 years. Baseline Rutherford ALI classifications were I (25.5%), IIa (32.7%), IIb (14.5%), and III (1.8%). Common lesion locations were the superficial femoral artery (56.4%) and the popliteal artery (58.2%). Complete thrombus removal was achieved in 60% of cases, with a technical success rate of 87%. Mechanical aspiration thrombectomy was utilized as the sole intervention in 25.5% of cases, and additional intraprocedural therapies included percutaneous transluminal angioplasty (34.5%) and catheter-directed thrombolysis (18.2%). In-hospital outcomes included a low rate of major amputation (3.6%) and mortality (1.8%). Complications were minimal, occurring in 5.5% of patients, with target lesion dissection (3.6%) and access site pseudoaneurysm (1.8%) being the most common.

Conclusion:

Mechanical aspiration thrombectomy is a safe and effective first-line treatment for ALI, providing high technical success and low complication rates. Mechanical aspiration thrombectomy can offer a valuable option for ALI patients. Future studies should focus on long-term outcomes, including freedom from amputation and cost-effectiveness compared to other treatment modalities.